Transitional Care Management

To increase the quality of patient care and reduce hospital re-admissions.

CPT Code 99495 – TCM services with moderate medical decision complexity (face-to-face visit within 14 days of discharge)
CPT Code 99496 – TCM with high medical decision complexity (face-to-face visit within 7 days of discharge)

The 30-day TCM period begins on the date the beneficiary is discharged from the inpatient hospital setting and continues for the next 29 days.

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Collection

COLLECTION

The purpose of collection is to find out what happened to the Dr’s money. Why is the claim not paid? What can we do to get a payment? You need to try and act as completely as possible: try to make sure that the actions you are performing will facilitate either a payment or finalization of the claim. The point is not to keep the claim open.

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Incident to Billing

Currently, there are two ways in which to bill Medicare for Non-physician Providers (NPP) services: direct (under the NPP`s name and NPI) and incident to (under supervising physician`s name and NPI).

“Incident to” services are defined as those services that are furnished incident to physician professional services in the physician’s office (whether located in a separate office suite or within an institution) or in a patient’s home.

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